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We report a case of idiopathic opacification of Berger's space in a 68-year-old man. The opacification was in the retrolental space between the crystalline lens and the anterior vitreous in the right eye. Opaque fluid was surgically removed, and chemical analysis detected a high concentration of protein and a low concentration of mucopolysaccharides. No underlying pathology was observed.
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PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (</=62 months at surgery) had surgery for after-cataract more often than children in the older age group (P<.01). Patients who did not receive an anterior vitrectomy had surgery for after-cataract more often (P<.01). Age at surgery and whether an anterior vitrectomy was performed did not significantly affect the EPCO score. The patients who had surgery for after-cataract had a significantly higher EPCO score (P<.001). The IOL remained centered in all eyes; no eye developed posterior synechias. CONCLUSIONS: This prospective study shows that cataract surgery with anterior vitrectomy is advantageous in younger patients concerning after-cataract formation. The AcrySof SA30AL maintains good centration, produces minimal inflammation, and is well tolerated in the pediatric eye.
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PURPOSE: To evaluate the safety of trypan blue 1% and indocyanine green (ICG) 0.5% in assisting visualization of anterior capsule during phacoemulsification in mature cataract. SETTING: Department of Ophthalmology, United Christian Hospital, Hong Kong, China. METHODS: This prospective randomized clinical trial comprised 46 eyes with mature cataract receiving phacoemulsification and posterior chamber intraocular lens implantation. They were randomized into 3 groups (trypan blue, ICG, and control without stain). Visual acuity, endothelial cell count, corneal clarity, anterior chamber reaction, and intraocular pressure (IOP) were documented before surgery and 1 week, 1 month, and 3 months postoperatively. The absolute phaco time was also recorded. RESULTS: There was no significant difference in absolute phaco time (P=.17), mean endothelial cell loss (P=.72 at 1 week, P=.43 at 1 month, and P=.60 at 3 months) and no significant correlation between the absolute phaco time and the change in endothelial cell count (P=.50 at 1 week, P=.10 at 1 month, and P=.60 at 3 months) in the 3 groups. None of the patients had postoperative IOP greater than 21 mm Hg. All eyes had clear corneas and a quiet anterior chamber 3 months after surgery. CONCLUSION: Both trypan blue 1% and ICG 0.5% are safe for assisting visualization of the anterior capsule during phacoemulsification of mature cataract.
Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.
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Modifications of a transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical) for removing cataracts and performing poster capsulotomy-anterior vitrectomy in children are reported.